Legislature(1993 - 1994)
04/14/1994 03:00 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 545 - DISCRIMINATION UNDER HEALTH INSURANCE Number 025 DIXIE HOOD, Licensed Marriage and Family Therapist, testified in support of HB 545. She said it was not possible for a board member of the Alaska Association for Marriage and Family Therapy to attend the meeting, but a document from Mercy Dennis, chair of the association's legislative committee, was made available to committee members. She presented the following statement: "My name is Dixie Hood. I am a licensed marriage and family therapist in private practice in Juneau. I am here to ask your support for HB 545. This bill would provide licensed marriage and family therapists parity with other licensed health care professionals in Alaska. In addition to private practice I have worked as a mental health clinician and as a substance abuse counselor with the Juneau Department of Health and Social Services. My training and experience includes working with clients who are experiencing depression, severe anxiety, eating disorders, phobias, schizophrenia and other serious mental disorders as well as clients who are suffering emotional stress from family or work situations. I developed a substance abuse treatment program at the State Correctional Center at Lemon Creek. I mention these things because some of you may have the idea that the work of marriage and family therapists is limited to minor personal problems or marriage and divorce counseling. "I would like to briefly describe my own experience in this profession in Alaska. Because of limited academic resources in this state, I went to California for clinical training. After two years of graduate school, 3,000 supervised hours, and written and oral exams, I earned licensure in California. In California one could not call themselves a counselor or do the work of counseling without such preparations and licensure. I returned to Alaska to work and learned that there were no standards or license for counselors and that only a state business license was required. For this I paid seven dollars and 50 cents. This was ten years ago. I inquired about the standard counseling fees in Juneau. Counselor friends told me that the going rate was 40 dollars per hour because that was half of what psychologists charged. Medical insurance would reimburse 50 percent for services provided by psychologists so 40 dollars was the amount a client had to pay out of pocket. Therefore, in order to compete, counselors charged 40 dollars. It was not a level playing field. As I established myself as a psychotherapist in the community I was able to increase my professional fee to a more supportable income. However, Juneau is a government town with many employees having good medical insurance. When seeking health services, they want maximum reimbursement. Licensed medical doctors, psychiatrists, and psychologists have been regularly reimbursed by insurance companies. When licensed social workers were added to the list of providers not to be discriminated against, that offered another level of service and fee options to perspective clients. Adding marriage and family therapists to this list would not expand the number of clients served or the cost. It would add an alternative level of treatment. This is comparable to nurse practitioners versus physicians for medical treatment. It can actually decrease the costs of service. Marriage and family therapists are qualified to do much of the same work as other licensed mental health professionals and can do it cheaper. In Juneau there is a shortage of psychiatrists. They often see clients only for the prescription and monitoring of medication and not for psychotherapy. There are often waiting lists for psychiatrists and psychologists because of insurance reimbursement considerations. In many smaller communities in Alaska there are neither psychiatrists nor psychologists nor social workers. "Passage of HB 545 would enable clients some reasonable options in choosing treatment. Thanks to lobbying efforts by the Alaska Association for Marriage and Family Therapy and the support of the legislature and the administration two years ago, there are now established standards for licensing marriage and family therapists in this state. Parity in terms of third party payment is the logical next step. The ability to conduct a private practice depends, to a significant extent, upon insurance and other forms of reimbursement. I urge you to move this bill forward. I would be glad to answer any questions." Number 080 REP. MULDER asked about the standards adopted for licensure in Alaska. Number 082 SHERRIE GOLL, Lobbyist, Alaska Association for Marriage and Family Therapy, replied that standards are similar to those in California and consist of a master's degree and 3,000 hours of supervision. MS. HOOD referred to a grandfather clause that enabled those who qualified to become licensed in Alaska last August. She said because she was licensed in California and was also a member of the American Association for Marriage and Family Therapy, she presented the necessary background to become licensed. REP. MULDER asked if there were people grandfathered-in who did not possess the minimum qualifications. MS. GOLL indicated that national standards had to be maintained. REP. MULDER asked if a master's level training was offered in Alaska. MS. HOOD said she thought the nearest program was in Seattle. It was pointed out that neither a social work program nor a master's level training program was available in Alaska. Number 097 REP. GREEN mentioned that nurse practitioners have certain restrictions as compared to physicians. Comparably, he posed a question about the limitations imposed on therapists when dealing with emotional or psychological problems. Number 101 MS. HOOD replied that she was trained and qualified to do psychological evaluations, diagnosis, and treatment within the range of her background experience. She stated she was not able to issue prescription medication or provide psychological testing. She added that some marriage and family therapists have the expertise to do that sort of testing and therefore the limitation would be in terms of experience. She said she has worked at in-patient psychiatric facilities and also at a day care center for chronic schizophrenics, so she has worked with a severely mentally ill population. Number 117 REP. GREEN asked if she would know if she was working with someone who was depressed as opposed to someone who was schizophrenic and needed psychiatric treatment. Number 120 MS. HOOD replied that her responsibility was to do an evaluation and determine if a situation was within the scope of her experience and training; if this was not the case, she would make an appropriate referral. Number 125 REP. MULDER said, "You mentioned it would be less expensive to have you included under this umbrella because you provide many of the same services for less cost. How do your average charges reflect against those of a licensed psychiatrist?" Number 129 MS. HOOD replied that her fee is 75 dollars and she believes the psychiatrists in Juneau charge 100-125 dollars, and psychologists charge 80-100 dollars. Number 134 REP. MULDER asked if it was reasonable to expect that her fee structure would change if insurance was involved. MS. HOOD said she did not think this would be the case. She explained that the Human Affairs Managed Care Organization determines an appropriate rate and will not offer reimbursement if someone charges more than what has been determined as fair. She said she knows of at least one psychologist in Juneau who experienced a problem being accepted as a preferred provider because insurance was reluctant to pay the additional amount that was being charged. Number 149 REP. MULDER asked if any insurance plans currently cover the services Ms. Hood provides. MS. HOOD replied in the affirmative. REP. MULDER asked about the tolerances currently provided by insurance companies. He posed a question about the upper level Ms. Hood could charge and still remain covered by insurance. MS. HOOD said she had not heard a stated figure. Number 150 REP. MULDER said he thought it was common practice that insurance companies allowed up to "x" amount of dollars. MS. GOLL (indiscernible) said the top limit is not really known because marriage and family therapists charge below that limit, and therefore what they do charge is acceptable. MS. HOOD said she thought the Juneau Department of Health and Social Services bills insurance companies at a higher amount for their clinicians than what private practice therapists charge. Number 160 REP. MULDER asked Ms. Hood if her practice was covered by state employee coverage. MS. HOOD said she could see clients who were state employees, but she had to do this in a roundabout way. She explained that a physician's referral and supervisory statement was needed because of the physician's license. She said physicians were very supportive of counseling because it often helped with medical symptoms, such as chronic headaches and stomach aches, which frequently have psychosomatic aspects. She added that she thought it a legitimate consideration to be working under her own license rather than a physician's. Number 174 REP. MULDER asked if the administration viewed this as a cost saving mechanism for health care. CHAIRMAN HUDSON indicated a zero fiscal note and stated that HB 545 simply adds marital and family therapists to the line for insurance so that they might receive treatment similar to that of other professionals. He said they had not received any negative remarks from the administration. Number 180 REP. MACKIE moved to pass CSHB 545(L&C) from committee with individual recommendations and zero fiscal note. Number 184 CHAIRMAN HUDSON, hearing no objection, declared it was so moved. CHAIRMAN HUDSON then announced HB 458 was the next order of business.